Daily Endocrinology Research Analysis
Three impactful endocrinology advances stand out today: a multicentre Lancet proof-of-concept shows endoscopic ultrasound-guided radiofrequency ablation can safely target left-sided aldosterone-producing adenomas with promising biochemical and clinical responses. A JCEM study identifies FSH×inhibin B and FSH×AMH products as simple, highly accurate biomarkers to distinguish congenital hypogonadotropic hypogonadism from self-limited delayed puberty. A meta-analysis finds once-weekly semaglutide yi
Summary
Three impactful endocrinology advances stand out today: a multicentre Lancet proof-of-concept shows endoscopic ultrasound-guided radiofrequency ablation can safely target left-sided aldosterone-producing adenomas with promising biochemical and clinical responses. A JCEM study identifies FSH×inhibin B and FSH×AMH products as simple, highly accurate biomarkers to distinguish congenital hypogonadotropic hypogonadism from self-limited delayed puberty. A meta-analysis finds once-weekly semaglutide yields greater weight and glycemic reductions than once-daily liraglutide with comparable safety.
Research Themes
- Minimally invasive endocrine interventions for primary aldosteronism
- Diagnostic biomarkers in adolescent male hypogonadism
- Comparative effectiveness of GLP-1 receptor agonists for weight loss and glycemic control
Selected Articles
1. Endoscopic, ultrasound-guided, radiofrequency ablation of aldosterone-producing adenomas (FABULAS): a UK, multicentre, prospective, proof-of-concept trial.
In 28 participants undergoing 35 EUS-RFA sessions for left-sided APAs, no prespecified major hazards occurred. All PET-CT–positive nodules were targeted, with localized radiotracer reduction and 75% achieving complete or partial biochemical cure; 43% achieved clinical cure of hypertension at 6 months. Findings support EUS-RFA as a safe adrenal-sparing alternative to surgery for selected left-sided APAs.
Impact: This proof-of-concept demonstrates a minimally invasive, adrenal-sparing treatment that could transform management of primary aldosteronism by avoiding AVS and adrenalectomy in selected patients.
Clinical Implications: For patients with left-sided APA who are unwilling or unfit for AVS and adrenalectomy, EUS-RFA in expert centers may offer a safe alternative with meaningful biochemical and blood pressure improvements; however, randomized comparative studies and longer follow-up are needed before widespread adoption.
Key Findings
- No prespecified major hazards (gastric/adrenal perforation, hemorrhage, organ infarction) occurred after EUS-RFA across 35 procedures.
- All PET-CT–positive nodules were successfully targeted and ablated, with localized reduction of radiotracer uptake at 3 months.
- Biochemical cure (complete or partial) achieved in 75% and clinical cure of hypertension in 43% at 6 months; some patients achieved normotension off medications.
- Technique provides an adrenal-sparing alternative to total adrenalectomy for left-sided APAs.
Methodological Strengths
- Multicentre prospective design with independent safety oversight and predefined endpoints
- Molecular imaging before and after ablation to objectively quantify target engagement
- Endoscopic ultrasound guidance enabling precise, incremental energy delivery
Limitations
- Non-randomized, single-arm feasibility with small sample size
- Limited to left-sided APAs near the stomach; generalizability to right-sided lesions unknown
- Short follow-up (3-month imaging, 6-month clinical) and some patients required two sessions
Future Directions: Conduct randomized trials comparing EUS-RFA versus adrenalectomy, extend to right-sided APAs, optimize energy dosing, and assess durability of biochemical and cardiovascular outcomes over years.
2. FSH and Sertoli Cell Biomarkers Accurately Distinguish Hypogonadotropic Hypogonadism From Self-limited Delayed Puberty.
In a prospective nested case-control of 65 adolescent males with delayed puberty, baseline FSH, AMH, and inhibin B outperformed LH and testosterone for distinguishing CHH from SLDP. Products FSH×inhibin B < 92 and FSH×AMH < 537 achieved sensitivity >93%, specificity ≥92%, predictive values >92%, and LR+ >12, retaining high performance even without red flags.
Impact: Provides simple basal biomarkers with excellent accuracy to resolve a common and consequential diagnostic dilemma in adolescent endocrinology.
Clinical Implications: Using FSH×inhibin B or FSH×AMH thresholds at baseline could streamline evaluation, reduce need for stimulation tests, and enable earlier targeted management for CHH versus watchful waiting in SLDP.
Key Findings
- Baseline FSH, AMH, and inhibin B showed superior diagnostic efficiency versus LH and testosterone.
- FSH (IU/L)×inhibin B (ng/mL) < 92 and FSH (IU/L)×AMH (pmol/L) < 537 achieved sensitivity >93%, specificity ≥92%, predictive values >92%, and LR+ >12 for CHH.
- High diagnostic performance persisted when excluding patients with red flags (micropenis, cryptorchidism, microorchidism).
- Prospective follow-up to definitive diagnosis (age 18 or ≥4 years after reaching testis volume 4 mL).
Methodological Strengths
- Prospective nested case-control with gold-standard longitudinal confirmation of diagnosis
- Objective, widely available serum biomarkers with predefined composite thresholds
- Direct comparison against standard LH/testosterone-based approaches
Limitations
- Modest sample size (n=65) and need for external validation in diverse populations
- Adolescent males only; generalizability to females or other age groups is unknown
Future Directions: Validate thresholds in multiethnic, larger cohorts; assess cost-effectiveness versus stimulation testing; integrate into diagnostic algorithms and decision-support tools.
3. Once-Weekly Semaglutide Versus Once-Daily Liraglutide for Weight Loss in Adults: A Meta-Analysis of Randomized Controlled Trials.
Across 3 RCTs (n=922), once-weekly semaglutide produced greater reductions in body weight (WMD −4.55), HbA1c (WMD −0.46%), and fasting plasma glucose (WMD −1.23 mmol/L) than once-daily liraglutide. Risks of severe and gastrointestinal adverse events were comparable between groups.
Impact: Directly informs drug selection within a widely used class of anti-obesity/antidiabetic agents with clear, clinically meaningful effect size advantages for semaglutide.
Clinical Implications: When choosing between GLP-1 RAs, once-weekly semaglutide should be favored for greater weight loss and glycemic improvement, assuming access and tolerability are acceptable; monitoring for class-related gastrointestinal effects remains necessary.
Key Findings
- Once-weekly semaglutide reduced body weight more than once-daily liraglutide (WMD −4.55).
- HbA1c (WMD −0.46%) and fasting plasma glucose (WMD −1.23 mmol/L) reductions were greater with semaglutide.
- Rates of severe and gastrointestinal adverse events did not differ significantly between agents.
Methodological Strengths
- Systematic review and meta-analysis restricted to randomized controlled trials
- Random-effects modelling with prespecified outcomes (weight, HbA1c, fasting glucose, safety)
Limitations
- Only three RCTs (n=922), limiting assessment of heterogeneity and subgroup effects
- Short- to mid-term outcomes; long-term efficacy, adherence, and rare adverse events remain uncertain
- Comparative dosing and background therapies may vary across trials
Future Directions: Head-to-head pragmatic trials with longer follow-up, cost-effectiveness analyses, and evaluations across obesity phenotypes and cardiometabolic risk strata.